Health privatization advances in Spain. This is confirmed by the latest report from the Federation of the Association for the Defense of Public Health (FADSP), which has been dissecting since 2014, with the available data, how private health has been gaining ground on public resources, measuring in each autonomous community what is the per capita spending on private insurance, what percentage of spending is dedicated to concerts with private entities or how many consultations with specialists are given outside the National Health System.
Andalusia breaks its record in referrals to private healthcare: 200 million euros, almost a million patients
Madrid and Catalonia continue to be positioned as the two communities with the most privatized health services, in that order. This is the case since the federation began to make these reports in 2014. The people of Madrid invested an average of 325 euros in private policies in the years 2020 and 2021 compared to 89 in Navarra or 94 in Cantabria and registered more than 900 consultations with specialists outside the SNS for every 1,000 inhabitants. The report indicates that the pandemic “has been used by several communities, especially that of Madrid” to “deepen the privatization drift” instead of reinforcing public health. Catalonia is at the forefront in the public money that is transferred to concerts with private health (24.5% of the investment) and in the percentage of private beds over the total (39%).
The situation in Andalusia is striking. Accustomed to being among the communities most reluctant to hand over health services to private companies, it has climbed positions in the last two reports to be placed within the territories with a "medium" degree of privatization. It is in sixth place compared to the eighth position it occupied in 2020. Eight years ago, in 2014, it was at the bottom in privatization with 13 communities ahead. The rise has coincided with the change of Government in the Board. PP and Ciudadanos co-govern the community since the beginning of 2019 and on June 19 early regional elections are called by decision of the regional president, Juan Manuel Moreno Bonilla. In 2017 and 2018, the community joined the group of territories with a medium level of privatization but never before had it been in such advanced positions.
Expenditure per capita on private insurance has grown from 140 euros to 155 and so has the number of civil servants who opt for mutual insurance companies (from 4.3% to 5.27%). “In 2014 and 2019, Andalusia was in the group with the lowest degree of privatization and now it is at the gates of those with the highest degree. It is evident, there has been a negative transformation of the health system”, said spokesperson Mariano Sánchez-Bayle at the press conference to present the report, in which he lamented the “lack of transparency” of public administrations. This makes it difficult to obtain specific and homogeneous data for all communities.
Andalusia broke its record for referrals to private healthcare in 2021. 200 million euros were spent on it, almost double that in 2019, for one million patients. Also, just a month ago the Andalusian Executive signed an extension of the agreements to provide Cádiz and Huelva with two new hospital centers managed by the Pascual Clinics in the face of public sector discomfort. The Government of Moreno Bonilla had promised in 2019 to build a regional hospital in Cádiz that would cover the province due to the progressive aging of the population, according to the president himself, but three years later the project is still just an idea.
Aragón, governed by the PSOE, is the one that has increased the most in spending on private insurance, although it does not reach the levels of Madrid, Catalonia, or the Canary and Balearic archipelagos. Aragonese citizens spend 447 euros per year on direct payments to health care providers, only behind Navarra (622), Madrid (464), Galicia (457) and Euskadi (449), although this figure is closely related to wealth that each territory has, Sánchez-Bayle has clarified.
Fewer and fewer communities are breaking away from this trend. Extremadura is the one that has resisted the most in recent years and the only one that has remained at a "low" level of privatization, according to the federation's classification, although the private sector -in this case minimally- has eaten space from the public sector in 2020 and 2021. It has happened in all territories without exception, the spokesman specified.
In the conclusions, Navarra, Euskadi, Castilla-La Mancha, La Rioja, Asturias and Cantabria improve their positions but this does not mean that they have necessarily stopped privatization since the classification is made on the basis of the comparison between communities.
Cantabria is the one with the lowest “privatizing” score this year. The more private beds, the more spending on health insurance or the more investment in concerts, the more points the territories add. Next to it is also Castilla-La Mancha.
"Low cost" health insurance is propaganda
The report assures that "the cuts and deterioration of Public Health have been and continue to be the main incentive for the growth of the private sector, and for this reason it is one of the strategies used to favor privatization" and regrets that the increase in Private insurance is "linked to greater inequality and exclusions because only people with more resources have access to these formulas." Private health has admitted for the first time that the increase in its patients is related to long waits to obtain an appointment at the health center or with specialists.
The Federation of Associations in Defense of Public Health considers that low cost private insurance is more propaganda than reality“. "They advertise at low prices, but they are designed for young and healthy people," said Sánchez-Bayle, who warns that insurers are not interested in sick people.
Graphics by Raul Sanchez.